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SAVE THE BABIES 



This Pamphlet was Prepared by 
L. EMMETT HOLT, M.D., LL.D. 

Professor of Diseases of Children in the College of Physicians an^ 

Surgeons (Columbia University), New York; Attending 

Physician to the Babies* Hospital 

AND 

HENRY L. K. SHAW, M.D. 

Clinical Professor of Diseases of Children in Albany Medical College 

(Union University), Albany, N. Y.; Attending Physician to 

St. Margaret's Hospital for Infants; Director of the 

Division of Child Hygiene, New York State 

Department of Health 



• 



" ~ - ^ ' 



American Medical Association 
Five Hundred and Thirty-Five North Dearborn Street 

CHICAGC) 



Copyright, 1915 

BY THE 

American Medical Association 






I. BEFORE THE BABY COMES 



Motherhood should cause no fear of trouble. 
Giving birth to a baby is natural and normal. 

As soon as you know a baby is coming, engage the 
best doctor you can afford and place yourself under 
his care. 

If you had one miscarriage, another may be pre- 
vented by proper treatment. 

If you cannot afford a doctor, apply to a hospital or 
dispensary where experienced doctors and nurses will 
advise and care for you. 

A nervous, overworked, underfed woman cannot 
expect to have a strong, vigorous healthy child. 

The expectant mother requires an extra amount oi 
sleep, and a day-time rest for an hour or two is desir- 
able. She should keep the windows open while she 
sleeps. 

Much climbing of stairs and the use of the sewing 
machine should be avoided during the later months of 
pregnancy. 

Hard household or factory work during the later 
months of preganacy tend to bring on miscarriages, 
or to make the child small and delicate. 

When labor is threatened before the proper time, 
the expectant mother should go to bed at once and 
remain perfectly quiet until the danger is over. 

Walks in the open air should be taken during the 
entire course of pregnancy. Exercise in the fresh air 
and housework with the windows open are better than 
medicine. 

Violent exercise in any form should be avoided. 

Daily bathing is necessary for the best health of 
the mother. 

At least one satisfactory movement of the bowels 
should take place every day; if there is any difficulty 



about this, the doctor should be consulted, for it is 
important. 

It is necessary to drink plenty of water so that the 
kidneys will act freely. 

Loose, comfortable clothing is essential to the com- 
fort of the mother and the welfare of the child. Skirts 
and dresses should hang from the shoulders; but no 
tight bands about waist or chest. 

Breasts and nipples should be kept clean and 
softened with a little vaseline each day ; this will make 
the act of nursing one of pleasure and satisfaction 
instead of one of pain and discomfort. 

Expectant mothers must have plenty of simple 
nourishing food ; the baby must not be starved before 
it is bom. Tea and crackers will not make milk and 
strength. Also, highly seasoned, rich and fried foods 
should be avoided.. Overeating surely taxes the organs 
which care for waste materials and may cause serious 
illness. 

DIET FOR MOTHERS 

The following diet is recommended during preg- 
nancy and nursing. 

All kinds of soups. 

All kinds of fresh fish, boiled and broiled. 

Meats — once a day — beef, mutton, lamb, veal, 
ham, bacon, chicken or turkey. 

Eggs — freely, one or two each day. 

All cooked cereals with milk and cream and sugar 

All stale breads, avoiding fresh bread and rich 
cake. 

All green vegetables — peas, string-beans, aspar- 
agus, cauliflower, onions, 'spinach, white and sweet 
potato, celery, lettuce and other plain salads with oil. 

Desserts of plain custard or pudding, ice cream; 
no pastry. 

Fruits should be freely taken ; all ripe raw fruits 
and cooked fruits. 

Drinks — milk, buttermilk, cocoa and plenty of 
water, one or two quarts daily ; tea and coflfee spar- 
ingly and not strong, once a day. No beer or other 
alcoholic drinks. 



II. WHAT TO PREPARE 



NECESSARY THINGS FOR THE BABY 

Three-quarter yard thin, light-weight flannel. 

Two light-weight woolen blankets. 

Three cotton and wool undershirts. 

Three flannel skirts. 

Three outing flannel gowns. 

Four cotton slips. 

One and one-half dozen diapers, 18 inches. 

One and one-half dozen diapers, 22 inches. 

One box boric acid. 

One box talcum powder. 

One piece Castile soap. 

One-quarter pound sterile gauze. 

One-quarter pound sterile absorbent cotton. 

Two dozen safety pins, large and small. 

One set of scales. 

NECESSARY THINGS FOR THE MOTHER 

Three nightgowns. 

One and one-half yards square oil cloth or rubber 
sheeting. 

Two pounds absorbent cotton. 

Two pounds sterilized gauze or equivalent in old 
clean linen. 



III. THE NEW-BORN BABY 



There should be a warm, soft blanket to receive him. 

The body should be oiled, not bathed. 

The eyes should be carefully cleansed with a satu- 
rated solution of boric acid, and into each eye the 
doctor or nurse should put two or three drops of a 
2 per cent, solution of nitrate of silver to prevent sore 
eyes and possibly blindness. 

He should be placed in a quiet, darkened room, 
properly protected against the cold but not sur- 
rounded with too many hot water bagfe or bottles. 

NURSING 

He should not be put to the breast for five or six 
hours. 

During the first twenty-four hours the baby should 
not nurse more than four times, but both breasts each 
time. If he cries much, he should have boiled water, 
but not any kind of tea, nor sugar and water. 

Beginning with the third day, when the milk usually 
comes, he should nurse regularly every three hours, 
alternating the breasts, or taking both breasts each 
time according to his appetite and the amount of milk 
secreted. He should not remain at the breast more 
than twenty minutes in all. 

Nursing times should be regular by the clock; 
tegular feeding means regular sleep and these things 
make the care of the baby much easier. 

In the beginning it is well to waken the baby at 
nursing time ; soon he forms the habit of waking him- 
self at the regular interval. 

In case the milk is delayed longer than the third day, 
the baby should be fed at three-hour intervals, but 
he should be regularly put to the breast first in order 
to stimulate the flow of milk. 



IV. REASONS WHY YOU SHOULD 
NURSE YOUR BABY 



Breast milk is always ready and is never sour. 

Breast milk does not have to be prepared or mea- 
sured. 

It is Nature's method and was intended for your 
baby. 

It will make your baby strong and healthy. 

It is absolutely free from germs and dirt. 

It protects your baby from many infants' diseases. 

It is §afer for the baby. Ten bottle-fed babies die 
to one fed on the breast. 

It is the only perfect food for the baby. 

It contains the proper elements of food in the right 
proportion for' the growing child. 

Breast-fed babies seldom have bowel trouble, which 
is so fatal in bottle-fed babies, especially during hot 
weather. 

Your baby will have the best chance of living if it 
is breast fed. 



V. ADVICE TO NURSING MOTHERS 



Keep yourself well. As long as you are well, your 
baby will probably be well. 

Don't get discouraged if you have but little milk 
at first. Feed the baby a little from the bottle after 
nursing when necessary; but do not give up nursing. 
Be patient and try again. 

Eat plain, nutritious food. Avoid salads, pickles 
and spicy foods. 

Drink plenty of water and milk. Avoid tea, coflfee 
and alcoholic beverages. 

Nurse the baby regularly. Feed him by the clock 
and not longer than twenty minutes at one time. 

Until he is four months old, nurse every three hours 
up to 10 p. m. and only once during the night ; seven 
nursings in twenty-four hours. 

After he is four months old, omit all night nursings ; 
give but six nursings in twenty- four hours. 

When six months old, nurse every four hours 
(usually giving both breasts each time) ; only five 
nursings in twenty- four hours. 

When the baby cries between feedings, give him 
cooled, boiled water without anything in it. 

Do not wean or give any other feeding without con- 
sulting a doctor. 



VI. WEANING FROM THE BREAST 



If a mother becomes pregnant, or has any serious 
or severe acute illness, the baby should be weaned. 

Under other circumstances, if the baby is thriving, 
the nursing should be continued for nine or ten months 
without other food. 

Weaning should be done gradually, if possible, by 
giving the baby at first one, and later two or more 
feedings from the cup or bottle in place of a nursing. 

The number of feedings should be gradually 
increased until the baby is taken entirely from the 
breast at eleven or twelve months. 

If the baby is weaned before eight months he should 
be taught to take the bottle ; if at ten or eleven months 
old, it is better to teach him to drink or feed from 
a spoon. 

If possible, weaning during the summer months 
should be avoided. 



VII. ARTIFICIAL OR BOTTLE-FEEDING 



There is no perfect substitute for breast milk. 

Clean fresh cow's milk properly modified is the 
best substitute available. 

Patent foods should be avoided ; they are not fresh ; 
they are expensive, and the babies fed on them are 
more liable to be sick than those fed on cow's milk. 

CARE OF THE MILK 

Buy only clean milk, from a clean milkman and keep 
it clean in your home. 

Buy for the baby the freshest milk you can get, 
but not the richest milk. 

If possible, only milk delivered in bottles should 
be used. 

Dipped milk is never clean and never quite safe ; 
dirt and flies are likely to get into it. 

If such milk is used, it should always be kept 
covered. 

When received, the milk should be put immediately 
on ice and kept there. Warm milk readily spoils and 
spoiled milk will make the baby sick. 

One should never leave an open pitcher out of doors 
for the milkman to pour milk into. 

One should never allow milk to stand about the 
house in open vessels nor on the steps in the sun. 

Not only the bottles and dishes used, but the hands 
of the mother should be very clean before preparing 
the milk. 

New rubber nipples should be boiled. All nipples 
after using should be carefully washed in soap and 
water "and kept covered in a glass containing boric 
acid or baking soda and water. They should be rinsed 
before using. 

Bottles should be rinsed when emptied and then 
kept filled with water. Before preparing the food for 



11 

the day they should be thoroughly washed with hot 
suds and placed for ten minutes in boiling water. 

During the summer the milk should always be boiled 
or pasteurized. Boiling milk kills the germs and makes 
the milk safer. 

In preparing the milk for the baby it is easier to 
fix the entire supply for the day at one time. The 
proper quantity for each feeding is put in a separate 
bottle. 

The milk may be pasteurized by placing these bot- 
tles in a deep saucepan filled with cold water and 
left on the stove until the water boils. Then remove 
from the stove to a table and allow the bottles of 
milk to stand in the hot water for twenty minutes. 
Then cool by placing them in cold water, afterwards 
putting them on ice. Rapid cooling is of great impor- 
tance. 

When milk is boiled, this should be done in the 
separate feeding bottles after it is prepared. 

A HOME-MADE ICE BOX 

This may be made as follows: Get from your 
grocer a deep box about 18 inches square and put 
3 inches of sawdust in the bottom. Place two pails 
in this box, one, a smaller pail, inside the other, and 
fill the space between the outer pail and the box with 
sawdust. The nursing bottles filled with milk are 
placed in the inner pail. This pail is then filled with 
cracked ice which surrounds the bottles. The inner 
pail should have a tin cover. Nail several thicknesses 
of newspaper on the under surface of the cover of 
the box. This ice-box should be kept covered and 
in a shady, cool place. The water from melted ice 
'should be poured off and the ice renewed at least once 
each day. 

• PREPARATION OF THE FOOD 

The simplest plan is to use whole milk (from a 
shaken bottle) which is to be diluted according to 
the child's age and digestion. 

Beginning on the third day, the average baby should 
be given 3 dunces of milk daily, diluted with 7 ounces 



12 

of water. To this should be added one tablespoonful 
of lime water and two level teaspoonfuls of sugar. 
This should be given in seven feedings. 

At one week, the average child requires 5 ounces 
of milk daily, which should be diluted with 10 ounces 
of water. To this should be added one and a half 
even tablespoonfuls of sugar and 1 ounce of lime 
water. This should be given in seven feedings. 

The milk .should be increased by i/^ ounce about 
every four days. 

The water should be increased by ^ ounce about 
every eight days. 

At three months, the average child requires 16 
ounces of milk daily, which should be diluted with 
16 ounces of water. To this should be added three 
tablespoonfuls of sugar and 2 ounces of lime water. 
This should be given in six feedings. 

The milk should be increased by ^ ounce about 
every six days. 

The water should be reduced by y^ ounce about 
every two weeks. 

At six months, the average child requires 24 ounces 
of milk daily, which should be diluted with 12 ounces 
of water. To this should be added 2 ounces of lime 
water and 3 even tablespoons ful of sugar. This should 
be given in five feedings. 

The amount of milk should be increased by ^ ounce 
every week. 

The milk should be increased only if the child is 
hungry and digesting his food well. It should not be 
increased unless he is. hungry, nor if he is suffering 
from indigestion even though he seems hungry. 

At nine months, the average child requires 30 ounces 
of milk daily, which should be diluted with 10 ounces 
of water. To this should be added two even table- 
spoonfuls of sugar and 2 ounces of lime water. This 
should be given in five feedings. 

The sugar added may be milk sugar or if this cannot 
be obtained cane (granulated) sugar or maltose 
(malt sugar). 



13 

At first plain water should be used to dilute the 
milk. 

At three months, sometimes earlier, a weak barley 
water may be used in the place of plain water; it is 
made ^ level tablespoon ful of barley flour to 16 
ounces of water and cooked for twenty minutes. 

At six months, the barley flour may be increased 
to 1^ even tablespoon fuls, cooked in the 12 ounces of 
water. 

At nine months, the barley flour may be increased 
to 3 level tablespoonfuls, cooked in the 8 ounces of 
water. 

A very large baby may require a little more milk 
than that allowed in these formulas. 

A small or delicate baby will require less than the 
milk allowed in the formulas. 

RULES FOR FEEDING 

Rules for bottle feeding must be carefully observed : 
regularity is very important. 

From the outset the babv should not be fed oftener 
than every three hours up to 10 p. m. and one feeding 
later during the night; only seven feedings in the 
twenty- four hours. 

After four months no night feeding after 10 p. m. 
should be given ; only six feedings in the twenty- four 
Hours. 

After six months the time between feedings should 
be made four hours and only five meals given in the 
twenty-four hours. 

The bottle should always be held while the child is 
taking his food. 

After feeding, the child should be placed upright 
and patted to allow him to bring up the gas, generally 
air which he has swallowed. He should then be placed 
in his crib, but not rocked. 

A child should never be played with after feeding. 

He should not be allowed to suck on an empty bottle. 

He should not be allowed to sleep with the nipple 
in his mouth. 



14 

If a child does not take all his feeeding, what is left 
should be thrown away; never warmed over again 
for a later feeding. 

Unless a child has loose bowels he should be given 
from one to three tablespoon fuls of strained fruit juice 
once a day after he is seven or eight months old. 

After he is nine months old, he may be given 
squeezed beef juice, beef tea or plain mutton or chicken 
broth, once a day. 

When he is ten months old, he may have part of 
a soft egg, a small piece of crisp toast or zwieback 
or a crust of bread to chew, immediately after his 
feeding. 

Other solid foods should not be given during the 
first year. 

At twelve months, he may take his milk undiluted 
and strained cereal may be given twice a day. 



VIII. FROM THE BOTTLE TO TABLE 

FOOD 



During the second year, the child should have four 
meals a day ; hours : 6 a. m., 10 a. m., 2 p. m., 6 p. m. 
Nothing but water should be allowed between his 
meals. 

At twelve months, the baby should be weaned from 
the bottle and taught to drink milk from a cup. 

He may then have cereals twice a day which should 
be thoroughly cooked and for the first two or three 
months they should be strained. 

He should have four cups of milk daily. 

When fifteen months old, he may have at first a 
teaspoonful, later one tablespoonful of rare scraped 
beef, mutton or chicken. 

When eighteen months old he may have one-half of 
a mealy baked potato daily. 

When two years old, he may have most of the fresh 
green vegetables when thoroughly cooked and finely 
mashed. 

Tea, coffee, cider, wine, beer, soda-water and candy 
should never be given to a young child. 

The juice of fresh fruits may be given after twelve 
months. 

Cooked fruit, such as baked apple or applesauce, 
should be given once a day after a child is eighteen 
months old; it should at first be strained. 

Stale, raw fruits are especially dangerous in the city 
and in the summer. 



IX. DIET 



TWO TO THREE YEARS. 

Breakfast — 7:50 A, M. 

The juice of one sweet orange or the pulp of four 
or five stewed prunes, or applesauce. 

Either a well-cooked cereal: corn meal, Petti John, 
oatmeal, cracked wheat, wheatena, all well salted and 
not more than one-half teaspoonful of sugar, and milk 
added ; or soft boiled or poached egg with stale bread 
or crisp toast. 

Glass of warmed milk. 

10:30 A. M, 

Glass of warmed milk. 

Dinner — /;jo to 2 P. M, 

One-half cup of broth or soup, which may be 
chicken, beef or mutton, thickened with barley or rice. 

Chop, rare roast beef, rare steak, or chicken or 
broiled fish. 

Boiled or baked potato. 

Asparagus tips, carrots, string teans, peas, spinach. 
All vegetables should be very thoroughly cooked and 
mashed. 

Dessert: baked apple, plain bread or rice pudding, 

corn starch, custard, junket, or stewed prunes with 

skins removed. 

Supper — 5:30 P. M. 

Well-cooked cereal, or bread and milk, or bread and 
butter and cocoa, and stewed fruit, applesauce. 
Glass of warmed milk. 
No food between meals. Water several times a day. 



X. THINGS WHICH ARE BAD FOR ALL 

BABIES 



Pacifiers. 

Thumb sucking. 

Soothing syrups. 

Patent medicines. 

Whisky or gin for supposed colic. 

Dirty playthings, dirty nipples, dirty bottles, dirty 
floors. 

Waterproof diapers except for temporary use. 

Moving picture shows. 

Violent rocking, bouncing and rollicking play at 
any time. 

Play of every sort after feeding. 

Kissing the baby on his mouth either by the family 
or by strangers. 

Testing the temperature of the baby's milk by taking 
the nipple in the mouth. 

Sucking on empty bottles. 

Sleeping on the mother's breast while nursing. 

Sleeping in bed with the mother. 

Spitting on handkerchief to remove dirt from baby's 
face. 

Sneezing and coughing in the baby's face. 

Allowing a person with a cough or cold to hold 
the baby. 

Allowing any person with tuberculosis to take care 
of the baby. 



The baby is not a toy or a plaything, but a great 
responsibility — its health, growth and happiness depend 
largely on you. 



XL THE SUMMER CARE OF BABIES 



THE BREAST-FED BABIES 

Breast milk is the best milk for the summer. 

Breast-fed babies seldom have severe diarrhea. 

If they vomit or have acute indigestion it is usually 
because they are fed too much or too often, or because 
the mother is so sick or tired out that her milk is poor. 

In very hot weather the baby should nurse less 
often. 

Give him the breast only every four hours, but give 
cooled boiled water freely between the nursings. 

THE BOTTLE-FED BABIES 

They are much more likely to get diarrhea. 

If they have diarrhea it is much more often severe. 

The milk must be clean and be kept cold. 
' It should be boiled or pasteurized. 

The bottles and rubber nipples should be boiled daily 
and kept very clean. 

In very hot weather the baby needs less food but 
more to drink. His milk should therefore be diluted 
with boiled water and cooled boiled water given freely 
between feedings. 

SUMMER DIARRHEA 

It is easier to prevent diarrhea than to cure it. 
The important means of preventing severe diarrhea 
are: 

1. Boil all milk in summer. 

2. Dilute the baby's food in very hot spells. 

3. Stop the food at once if an acute diarrhea begins. 
If the movements become loose and only two or 

three a day, do not neglect it because the baby happens 
to be teething ; it may mean the beginning of a serious 
illness. 

Dilute the food with an equal amount of boiled 
water and give less than the usual amount at a feeding. 



19 

If the movements are more frequent and there is 
vomiting or fever, stop all food at once and give only 
boiled water, and call a doctor. 

After twelve hours without food, barley water, 
made one tablespoon ful to one pint, may be given. 

Proper treatment at the beginning of a diarrheal 
attack is worth more than many days' treatment later. 

GENERAL CARE 

The clothing in hot weather should be light and on 
very hot days only the shirt, band and napkin worn. 

Bathe the baby morning and evening and on hot 
days also in the middle of the day. 

Keep the skin clean and well powdered. 

Napkins when soiled should be placed at once in 
water and washed as soon as possible. 

The baby needs fresh air quite as much as fresh 
food. 

Keep him out of doors as much as possible. 

Avoid the sun on hot days. 

In very hot weather take him out early in the morn- 
ing and in the late afternoon and early evening. 

It is often cooler in the house, with shutters closed, 
in the middle of the day. 

Take the baby to the park, to the beach and to the 
country whenever you can. 

AVOID INFECTION 

Keep the room free from soiled clothes and rubbish. 

Do not let the baby play with cats or dogs. Cats 
and dogs carry diseases to babies. 

Do not let the baby crawl around on a dirty floor or 
dusty carpet. Place him on a clean sheet or blanket. 

Keep playthings and pacifiers out of his mouth. 

Flies carry disease to babies. Screen the baby's 
room. 

Keep flies away from the baby and his food at all 
times. 

Cover the crib or carriage with netting to keep out 
the flies and mosquitoes. 





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To avoid fine, this book sliouid be returned oo 
or before the date last stamped below 


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